Provider Demographics
NPI:1740025048
Name:MIDHA, VISHU
Entity type:Individual
Prefix:
First Name:VISHU
Middle Name:
Last Name:MIDHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 STABLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5192
Mailing Address - Country:US
Mailing Address - Phone:530-491-3638
Mailing Address - Fax:
Practice Address - Street 1:1877 STABLER PARK DR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-5192
Practice Address - Country:US
Practice Address - Phone:530-491-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist